Is the Most Common Therapy for Autism Cruel? [Repost]

Trigger warning: ABA, aversives.
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When parents learn that their child is autistic, they are naturally interested in interventions to help their child that have a proven track record. At least in the United States, Applied Behavior Analysis (ABA) is often the first-line therapy recommended, and some insurance plans exclusively cover ABA. On this week’s post, I am sharing an article that summarizes the complex history and controversy around ABA.

At its core, ABA seeks to encourage behaviors deemed as “desirable” by society, while discouraging other behaviors deemed as “undesirable.” It works by changing reward structures. For many autistic people, “desirable” behaviors like making eye contact and speaking may be innately challenging or uncomfortable. An ABA program will create artificial rewards for these behaviors so that the child becomes motivated to engage in them. The darker flip side of some ABA programs involves punishments, or “aversives” to deter behaviors deemed as “undesirable” even when such behaviors may serve an innate functional purpose for the child.

As I read the article below, it made me think about how the definition of “evidence-based practice” may be more complex than it seems. A practice may lead to objectively demonstrable changes in an outcome, but are those outcomes truly positive for the participants? ABA does have an evidence base in terms of being linked to behavior changes deemed positive by neurotypical educators. But, these changes could come at a cost to the participants’ identities, and particularly aversive forms of ABA can cause lasting harm which could outweigh any benefits. As with most things, the best solution may be a hybrid approach that integrates components of ABA while still respecting the child’s neurology-“a focus on teaching skills, rather than normalization or suppressing autism-related behaviors.”Is Applied Behavior Analysis, the Most Common Therapy for Autism, Cruel?